Public Health Initiatives to Address the Opioid Crisis Task Force - PowerPoint PPT Presentation

Public Health Initiatives to Address the Opioid Crisis

Task Force (1/2) Robert P. Pack, PhD, MPH - Chair Andrew Kolodny, MD • East Tennessee State University College of Public • Brandeis University Health Brandon D.L. Marshall, PhD Caleb J. Banta-Green, PhD, MPH, MSW • Brown University School of Public Health • University of Washington School of Public Health William C. Miller, MD, PhD, MPH Donald S. Burke, MD • The Ohio State Univ. College of Public Health • University of Pittsburgh Graduate School of Public Brendan Saloner, PhD Health • Johns Hopkins Bloomberg School of Public Health Hannah Cooper, ScD, ScM Michael D. Stein, MD • Rollins School of Public Health at Emory University • Boston University School of Public Health Judith Feinberg, MD Sten H. Vermund, MD, PhD • West Virginia University School of Medicine • Yale University School of Public Health Cheryl G. Healton, DrPH, MPA April M. Young, PhD, MPH • New York University College of Global Public • University of Kentucky School of Public Health Health Kimberly A. Horn, EdD, MSW • Virginia Tech Carilion Research Institute

Task Force (2/2) Ex Officio Staff Linda P. Fried, MD, MPH Laura Magaña, PhD • Dean, Columbia Univ. Mailman School of • President and CEO, ASPPH Public Health Tony Mazzaschi • Chair, ASPPH Research Committee • Senior Director, Policy and Research, ASPPH Paul K. Halverson DrPH, FACHE Jennifer Salopek • Founding Dean, Indiana University Richard M. • Science Writer Fairbanks School of Public Health – Indianapolis • Chair, ASPPH Academic Practice Committee Boris D. Lushniak MD, MPH, RADM, USPHS (Ret) • Dean, Univ. of Maryland School of Public Health • Chair, ASPPH Advocacy Committee

Charge to the Task Force To identify and define evidence-based public health initiatives for the prevention and treatment of opioid use disorder (OUD), the mitigation of other consequences of opioid use, and in consideration of related and emerging substance use problems that might be undertaken with revenue resulting from litigation brought by public-sector entities (states, territories, tribes, cities, or localities) against opioid manufacturers and distributors; and, elucidate why such approaches are essential and how they complement other policy initiatives that address harmful substance use.

Foundational Principles Opioid crisis is a public The opioid crisis has both Addiction is a chronic, health issue, not a criminal social determinants and relapsing brain disease justice issue corporate determinants Consideration of the Scale of the synergistic Recommendations aligned syndemics/synergistic epidemics demand a multi- with guiding principles of epidemics of OUD, HCV, pronged public health public health HIV and other outcomes approach, not unlike the related to the same drivers Ryan White Care Act.

Recommendations Evidence and Anti-Stigma and Harm Primary Prevention Epidemiology Reduction Regulatory and Access to Medications Research and Legislative Reforms; for Opioid Use Evaluation Changes in Industry Disorder Business Practices

Recommendations: Evidence and Epidemiology The public health community and its partners must be equipped with the necessary data to understand the size, scope, and location of need of the opioid epidemic. The recommendations in this area will help us improve metrics, standardize systems, leverage technology and tools, and share and analyze data to combat the epidemic.

Recommendations: Anti-Stigma and Harm Reduction The Task Force feels strongly that OUD is not widely understood as a medical illness; reducing stigma around OUD can improve access to treatment and harm reduction programs. These recommendations are directed at educating healthcare professionals and the public, reducing barriers to medications for OUD, promoting recovery, and spreading evidence-based harm reduction programming.

Recommendations: Primary Prevention • Primary prevention strategies for preventing opioid misuse are critical to stopping the epidemic and should be focused on youth and the public at large • Credible prescriber and dispenser training created by an independent organization • Academic detailing and enhanced training for healthcare workers can help correct the inaccurate and misleading claims made by drug manufacturers • Expansion of drug disposal sites is a useful primary prevention strategy

Recommendations: Access to MOUD • Facilitate local access to MOUD • Deregulate buprenorphine prescribing • Maximize the use of telemedicine • Suspend the need for X waivers • Expand role of pharmacists in identifying and treating OUD • Encourage and leverage partnerships among prevention specialists, treatment providers, corrections personnel, and law enforcement to ensure continuity of care for opioid use disorder upon discharge from jail, prison, or drug court

Recommendations: Research and Evaluation • Establish a multi-site, multi-institutional collaborative, coordinated evaluation structure that will leverage the strengths of different universities and agencies • Expand research into the causes and remedies for the psychosocial drivers of the substance use epidemic • Dissemination and implementation studies to speed up adoption of evidence-based treatment, prevention and harm reduction • Conduct computational modeling and simulation to enhance early detection • Study clinical treatment decision support tools to integrate treatment into mainstream healthcare

Recommendations: Regulatory & Legislative Reforms • Modify FDA review and approval of applications for pain medications • Discontinue the promotion of opioids for long-term use for chronic non-cancer pain except for palliative and end-of-life care • Adopt the recommendations of the National Academies of Sciences for a revised cost-benefit framework • Approve an affordable, accessible form of naloxone • Impose post-market requirements on opioid manufacturers • Modernize and resource data and sentinel surveillance programs, including DATA 2000 to eliminate the X waiver

Recommendations: Adapt the Ryan White Model We recommend a comprehensive program for OUD treatment and SUD prevention similar to the Ryan White Comprehensive AIDS Resources Emergency Act • "Payer of last resort" that funds treatment when no other resources are available • Funds primary medical care providers • Focus on early detection and prevention • Funds essential support services • Healthcare provider training programs • Platform for dissemination of best practices • Relies on stakeholder engagement & input • Rigorous program evaluation components

Recommendations: Industry Changes • Voluntarily end all lobbying and marketing activities related to opioids and other drugs of potential abuse • Fund (but NOT manage or control) one or more independent campaigns aimed at educating the public about the risk of opioids and the availability of treatment options.

Why This Matters 82,000 47,600 Total Death Toll 700,000+ 2016-2025 2025 2017

More Information and Resources http://www.ASPPH.org/opioids/ or advocacy@ASPPH.org